Management of sleep apnea in children – PEMBlog

There are many infants and children that have sleep apnea – categorized as obstructive, central, and a mix of both. The cumulative risk of untreated sleep apnea is an increase in neurobehavioral deficits and cardiovascular morbidity. Management is based on data assessed via the apnea-hypopnea index (AHI)  which is the combined average number of apneas and hypopneas that occur per hour of sleep during a polysomnography (sleep study). The American Academy of Sleep Medicine specifies the following treatment recommendations based on AHI values:

  • Treatment for anyone with an AHI >5
  • For children with comorbidities (like CP, neuromuscular disease, etc.) if AHI 1-5

In children under the age of 2 years the therapy of choice is supplemental home oxygen. This can be titrated over time. I often see children in the ED with sleep apnea on home oxygen therapy who get a respiratory infection and have desaturations at home and have to increase their flow rate. These children will often be admitted.

In children aged 2 to 5 years adenotonsillectomy has an 80% success rate if there is adenoid and tosillar hypertrophy.  CPAP is an option for children older than 6 years (they can tolerate it better at that age). Weight loss strategies are employed for overweight children. 

Carole L. Marcus, Lee Jay Brooks, Kari A. Draper, David Gozal, Ann Carol Halbower, Jacqueline Jones, Michael S. Schechter, Stephen Howard Sheldon, Karen Spruyt, Sally Davidson Ward, Christopher Lehmann, Richard N. Shiffman; Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics September 2012; 130 (3): 576–584. 10.1542/peds.2012-1671

Katz ES, Marcus CL. Diagnosis of obstructive sleep apnea syndrome in infants and children. Principles and practice of pediatric sleep medicine. Elsevier Saunders. 197-210; 2005.

Bitners AC, Arens R. Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome. Lung. 2020 Apr;198(2):257-270. doi: 10.1007/s00408-020-00342-5. Epub 2020 Mar 12. PMID: 32166426; PMCID: PMC7171982.

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